Minimally invasive resection of adrenal masses in infants and children: results of a European multi-center survey View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-05-26

AUTHORS

Francesco Fascetti-Leon, Giovanni Scotton, Luca Pio, Raimundo Beltrà, Paolo Caione, Ciro Esposito, Girolamo Mattioli, Amulya K. Saxena, Sabine Sarnacki, Piergiorgio Gamba

ABSTRACT

BackgroundMinimal access adrenal surgery (MAAS) for adrenal pathologies is the standard for many pediatric surgical centers. However, the literature offers few reports and minimal evidence from small case series. The aim of this study was to evaluate the outcomes of pediatric MAAS through a multi-center data analysis.MethodPediatric patients who underwent MAAS between January 2002 and December 2013 were retrospectively included. Data analysis was conducted using Spss software (Welch's t-test, X-square, Fisher tests, multiple regression model).ResultsSix European centers participated, 68 patients were included with mean age of 5.2 years (2 months–16 years). Lesion volume was of 18.1 cc (0.78–145.6), with a mean diameter of 2.8 cm (1.1–6.5). Localization was 50% left-sided masses, 45.6% right-side masses, and 4.4% bilateral. Histological examination revealed 36 neuroblastomas, 15 adenomas, nine pheochromocytomas, three ganglioneuromas, two ganglioneuroblastomas, one bilateral hyperplasia, one adrenocortical carcinoma, an alveolar sarcoma, and a calcification. Surgical access was transperitoneal in 63 (92.6%) and retroperitoneal in 5 (7.4%). Mean operative time was 170 ± 87 min (285 ± 30 min for bilateral lesions). Mean hospital stay was 4.2 ± 2.5 days. Complications included blood loss requiring transfusion in five patients (7.4%) and a diaphragmatic tear. Infiltration of surrounding structures correlated with intraoperative complication rate (p = 0.027) and operative time (p < 0.01). No mass rupture, conversion, or post-operative complications were observed. Median follow-up was 52 months (1–161). Two recurrences occurred in patients with pheochromocytoma. Age, weight, symptoms, characteristics at imaging, chemistry, volume, or histology, did not influence operative time, hospital stays, or complication rate.ConclusionsPediatric MAAS was safe adopted for masses up to 145.6 cc, with a very low rate of complication. Conversion to open is not necessary even in the presence of infiltrations. MAAS should represent the first-line treatment for selected cases in centers experienced in laparoscopy. More... »

PAGES

4505-4512

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-017-5506-0

DOI

http://dx.doi.org/10.1007/s00464-017-5506-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1085609301

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28550366


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    "description": "BackgroundMinimal access adrenal surgery (MAAS) for adrenal pathologies is the standard for many pediatric surgical centers. However, the literature offers few reports and minimal evidence from small case series. The aim of this study was to evaluate the outcomes of pediatric MAAS through a multi-center data analysis.MethodPediatric patients who underwent MAAS between January 2002 and December 2013 were retrospectively included. Data analysis was conducted using Spss software (Welch's t-test, X-square, Fisher tests, multiple regression model).ResultsSix European centers participated, 68 patients were included with mean age of 5.2\u00a0years (2 months\u201316 years). Lesion volume was of 18.1\u00a0cc (0.78\u2013145.6), with a mean diameter of 2.8\u00a0cm (1.1\u20136.5). Localization was 50% left-sided masses, 45.6% right-side masses, and 4.4% bilateral. Histological examination revealed 36 neuroblastomas, 15 adenomas, nine pheochromocytomas, three ganglioneuromas, two ganglioneuroblastomas, one bilateral hyperplasia, one adrenocortical carcinoma, an alveolar sarcoma, and a calcification. Surgical access was transperitoneal in 63 (92.6%) and retroperitoneal in 5 (7.4%). Mean operative time was 170\u2009\u00b1\u200987\u00a0min (285\u2009\u00b1\u200930\u00a0min for bilateral lesions). Mean hospital stay was 4.2\u2009\u00b1\u20092.5\u00a0days. Complications included blood loss requiring transfusion in five patients (7.4%) and a diaphragmatic tear. Infiltration of surrounding structures correlated with intraoperative complication rate (p\u2009=\u20090.027) and operative time (p\u2009<\u20090.01). No mass rupture, conversion, or post-operative complications were observed. Median follow-up was 52\u00a0months (1\u2013161). Two recurrences occurred in patients with pheochromocytoma. Age, weight, symptoms, characteristics at imaging, chemistry, volume, or histology, did not influence operative time, hospital stays, or complication rate.ConclusionsPediatric MAAS was safe adopted for masses up to 145.6\u00a0cc, with a very low rate of complication. Conversion to open is not necessary even in the presence of infiltrations. MAAS should represent the first-line treatment for selected cases in centers experienced in laparoscopy.", 
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30 schema:description BackgroundMinimal access adrenal surgery (MAAS) for adrenal pathologies is the standard for many pediatric surgical centers. However, the literature offers few reports and minimal evidence from small case series. The aim of this study was to evaluate the outcomes of pediatric MAAS through a multi-center data analysis.MethodPediatric patients who underwent MAAS between January 2002 and December 2013 were retrospectively included. Data analysis was conducted using Spss software (Welch's t-test, X-square, Fisher tests, multiple regression model).ResultsSix European centers participated, 68 patients were included with mean age of 5.2 years (2 months–16 years). Lesion volume was of 18.1 cc (0.78–145.6), with a mean diameter of 2.8 cm (1.1–6.5). Localization was 50% left-sided masses, 45.6% right-side masses, and 4.4% bilateral. Histological examination revealed 36 neuroblastomas, 15 adenomas, nine pheochromocytomas, three ganglioneuromas, two ganglioneuroblastomas, one bilateral hyperplasia, one adrenocortical carcinoma, an alveolar sarcoma, and a calcification. Surgical access was transperitoneal in 63 (92.6%) and retroperitoneal in 5 (7.4%). Mean operative time was 170 ± 87 min (285 ± 30 min for bilateral lesions). Mean hospital stay was 4.2 ± 2.5 days. Complications included blood loss requiring transfusion in five patients (7.4%) and a diaphragmatic tear. Infiltration of surrounding structures correlated with intraoperative complication rate (p = 0.027) and operative time (p < 0.01). No mass rupture, conversion, or post-operative complications were observed. Median follow-up was 52 months (1–161). Two recurrences occurred in patients with pheochromocytoma. Age, weight, symptoms, characteristics at imaging, chemistry, volume, or histology, did not influence operative time, hospital stays, or complication rate.ConclusionsPediatric MAAS was safe adopted for masses up to 145.6 cc, with a very low rate of complication. Conversion to open is not necessary even in the presence of infiltrations. MAAS should represent the first-line treatment for selected cases in centers experienced in laparoscopy.
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37 European Centre
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41 adenomas
42 adrenal masses
43 adrenal pathology
44 adrenal surgery
45 adrenocortical carcinoma
46 age
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48 alveolar sarcoma
49 analysis
50 bilateral hyperplasia
51 blood loss
52 calcification
53 carcinoma
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58 chemistry
59 children
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64 days
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70 ganglioneuroblastoma
71 ganglioneuroma
72 histological examination
73 histology
74 hospital stay
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76 imaging
77 infants
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79 intraoperative complication rate
80 invasive resection
81 laparoscopy
82 left-sided mass
83 lesion volume
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85 localization
86 loss
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88 mass
89 mean age
90 mean diameter
91 mean hospital stay
92 min
93 minimal evidence
94 months
95 multi-center survey
96 neuroblastoma
97 operative time
98 outcomes
99 pathology
100 patients
101 pediatric surgical centers
102 pheochromocytoma
103 post-operative complications
104 presence
105 presence of infiltration
106 rate
107 recurrence
108 report
109 resection
110 results
111 right side mass
112 rupture
113 sarcoma
114 series
115 small case series
116 software
117 spss software
118 standards
119 stay
120 structure
121 study
122 surgery
123 surgical access
124 surgical centers
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126 symptoms
127 tears
128 time
129 transfusion
130 treatment
131 volume
132 weight
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